Beyond Hyperactivity: Surprising Symptoms of Adult ADHD

ADHD has long been viewed through a much too narrow lens, resulting in many adults and many children (especially females) going undiagnosed, misdiagnosed, or being diagnosed late. (1) 

At the same time, I do think there’s been an increased awareness lately of how ADHD can manifest in different groups, like high-functioning adults, with many people sharing their experiences online and in public spaces. 

I’m a big supporter of embracing and understanding our individual minds and neurodiversity. And I know there’s a lot of confusion around the subject, so I wanted to share some of the most overlooked symptoms of adult ADHD, and what they might look like in your life. 

As I’m sure you know, an article can’t diagnose you, but I hope this can help point you in the right direction so that you can understand yourself better and truly thrive. 

Attention-Deficit/Hyperactivity Disorder: An Overview

Before we get into the lesser known symptoms, what is ADHD? While it’s often oversimplified, ADHD is a complex and nuanced condition that looks different for everyone, and often overlaps with other conditions including anxiety, depression, or learning disabilities. There’s also an overlap between ADHD and other forms of neurodivergence including autism. 

According to the DSM-5 (diagnostic and statistical manual of mental disorders), there are three main types of ADHD: inattentive, hyperactive-impulsive, and combined presentation. 

In children, the hyperactive-impulsive type is often easier to spot, but in adolescents and adults the signs are often more subtle (more on this below). Standard diagnosis of ADHD usually occurs in a primary care or psychiatry setting. 

Why ADHD Gets Missed In Adults

There are a few reasons why ADHD is often missed in adults. And in most cases, it was also missed in childhood (as opposed to just developing later in life). 

The Diagnostic Gap 

First, there’s a significant diagnostic gap between boys and girls in childhood. While this is not always the case, boys are more likely to present with the “classic” symptoms of ADHD, like disruptive hyperactivity. Girls, on the other hand, are more likely to experience inattentiveness, shyness, or space out in class, signs that are less “obvious” and often overlooked. (2) This discrepancy continues into adulthood, with women’s symptoms more likely to be missed. 

Masking & High-Functioning ADHD 

As they get older, both men and women with undiagnosed ADHD often develop sophisticated coping strategies in order to “pass” as being organized and on top of things. This can look like overworking, developing elaborate reminder systems, or making light of struggles that feel embarrassing. Many adults with ADHD lead busy, successful lives, but are often exhausted and can experience significant burnout if ADHD isn’t recognized. (3) 

Internal Symptoms 

Many of the most common symptoms of ADHD, especially for adults (and particularly for adult women) are more internal than external. This is sometimes described by the analogy of an iceberg: on the surface, others might see forgetfulness or fidgeting. But beneath the surface, there may be numerous hidden struggles with things like emotional regulation, time perception, and self-esteem. 

10 Surprising Adult ADHD Symptoms

Here are some of the most commonly missed symptoms of adult ADHD. As you read through these, there are a few important things to keep in mind. 

First, every individual ADHD case is different, and not everyone experiences all of these symptoms. You may also experience additional symptoms not listed here. 

Second, several different medical conditions, mood disorders, personality disorders, anxiety disorders, mental health conditions, and imbalances can look like ADHD. 

For example, brain fog and memory issues may be related to gut or hormonal imbalances, and not ADHD, which is one of the reasons why it’s important to work with a medical professional who can assess your case and rule out other causes. 

Finally, as you’re considering whether these symptoms apply to you, ask yourself whether they’re interfering with your daily life, work, or relationships. Almost everyone procrastinates here and there or has experienced brain fog or inattentive symptoms during a stressful time, and this alone doesn’t necessarily point to ADHD. 

#1. Time Blindness 

People with ADHD often struggle to keep track of, manage, and/or plan their time. This is due to an underlying difficulty in perceiving the passing of time. (4) For example, you may think that you can get way more done in a day than you can, or think you’re leaving on time for an event but not realize how much time it will take you to get ready. 

#2. Hyperfocus 

A lot of people talk about lack of focus with ADHD, but in reality focus is often inconsistent: you may struggle to concentrate on something you’re trying to get done, but when something actually interests you, you can become fixated on it, focusing intensely and often for long periods of time. This can be great for completing the projects you care about! But it can make it challenging to complete necessary tasks that don’t interest you as much. 

#3. Emotional Dysregulation

Emotional regulation is an executive function, and it can be a challenge for adults with ADHD. Mood swings, irritability, emotional outbursts, or feeling “too much” can all occur, and may point to adult ADHD when combined with other symptoms. 

LISTEN: What If Your Brain Fog, Burnout & Mood Swings Are Actually ADHD? | Dr. Jolene Brighten 

#4. Procrastination & Last Minute Work 

One of the most common symptoms of ADHD is putting things off until the last minute. At that last minute, you may be able to do your best work, when a rush of adrenaline steps in to motivate you and engage your executive functions. 

#5. Burnout

Having undiagnosed ADHD as an adult often means living and running life on “overdrive” to keep up with neurotypical expectations. Many adults with ADHD appear very successful on the outside, but on the inside are dealing with frequent crashes and exhaustion. 

#6. Sensory Sensitivities 

Having ADHD can mean that your sensory system is chronically overstimulated. You may be sensitive to bright lights, certain textures in clothing or on furniture, loud environments, or strong scents, especially if there’s a lot going on around you. (5) 

#7. Fatigue & Brain Fog

Even though we typically associate ADHD with hyperactivity, many adults with ADHD feel drained and tired a lot of the time. Many adults with ADHD also experience chronic brain fog or a feeling of sluggishness, confusion, or difficulties with thinking or memory. This can result in part from racing thoughts, sensory overstimulation, trying to keep up, and disrupted or insufficient sleep.

#8. Self Criticism Or Low Self-Esteem

Because of our society’s definition of success and a world built around neurotypical individuals, many people with ADHD carry deep shame or negative self-talk around their struggles with time management, completing tasks, or what others might perceive as “laziness” or “careless mistakes”. 

#9. Trouble Sleeping

Insomnia and sleep problems are common among those with ADHD. (6) You might feel anxious, restless, or experience racing thoughts at night, making it difficult to fall (or stay) asleep. Circadian rhythms are often disrupted for those with ADHD, and you may also experience daytime sleepiness. 

READ NEXT: The Top 10 Ways To Improve Your Sleep, According To A Functional Medicine Expert 

#10. Impulsivity 

Impulsive behavior can show up differently in different people, and it’s not always as obvious as blurting things out. Some examples may be overspending or simply saying yes to too many different things. Others may struggle with substance misuse or substance abuse. 

What To Do If You Have Adult ADHD

If you suspect or know you have adult ADHD, this is likely the beginning of a path towards greater clarity and understanding of yourself. It can be empowering to know why you might feel “different” in some ways, or like certain things are harder for you than for those around you. 

There are also many things you can do to reduce the symptoms that interfere most with your life. The point isn’t to completely alter the way your brain works; instead, you can honor your neurodivergence while also healing any underlying imbalances that are contributing to things like insomnia or brain fog. 

Conventional healthcare often relies on ADHD medications, including stimulant medications (such as methylphenidate or amphetamines), which often come with side effects and are not an effective treatment for everyone. 

From a functional medicine perspective, I prefer to use non-stimulant approaches whenever possible, and take a bigger picture, whole person approach to what’s going on behind the scenes with ADHD. This includes addressing nutritional deficiencies, food intolerances, and imbalances, and using dietary, herbal, and lifestyle strategies that are tailored to the individual.

READ MORE: 11 Best Natural Remedies And Alternative Treatments For ADHD 

Therapeutic approaches are another important piece of the puzzle. Cognitive behavioral therapy (CBT) has been shown to be an effective intervention for many (but not all) adults with ADHD, and other forms of coaching or psychotherapy may also be helpful. (7) Many people also benefit from support groups or communities where they can connect with other people who relate to their ADHD experience. 

Every ADHD Case Is Different

I hope this article has helped you see some of the different ways that adult attention-deficit/hyperactivity disorder can show up. In reality, everyone’s experience is different. But if you find yourself relating strongly to several of the symptoms mentioned above, it may be worth exploring further with your trusted healthcare provider. If you’re looking for an individualized, functional medicine approach and holistic treatment options for yourself or a family member, you can book a consult with our functional medicine telehealth center.

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.

Sources

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  Martin, J. (2024). Why are females less likely to be diagnosed with ADHD in childhood than males?. The Lancet Psychiatry, 11(4), 303-310.
• Turjeman-Levi, Y., Itzchakov, G., & Engel-Yeger, B. (2024). Executive function deficits mediate the relationship between employees’ ADHD and job burnout. AIMS public health, 11(1), 294.
• Ptacek, R., Weissenberger, S., Braaten, E., Klicperova-Baker, M., Goetz, M., Raboch, J., … & Stefano, G. B. (2019). Clinical implications of the perception of time in attention deficit hyperactivity disorder (ADHD): A review. Medical science monitor: international medical journal of experimental and clinical research, 25, 3918.
• Kooij, J. S., & Bijlenga, D. (2014). High prevalence of self-reported photophobia in adult ADHD. Frontiers in neurology, 5, 256.
• Wajszilber, D., Santiseban, J. A., & Gruber, R. (2018). Sleep disorders in patients with ADHD: impact and management challenges. Nature and science of sleep, 453-480.
• Liu, C. I., Hua, M. H., Lu, M. L., & Goh, K. K. (2023). Effectiveness of cognitive behavioural‐based interventions for adults with attention‐deficit/hyperactivity disorder extends beyond core symptoms: A meta‐analysis of randomized controlled trials. Psychology and psychotherapy: theory, research and practice, 96(3), 543-559.